With the worldwide increase of commercial LASIK clinics, almost every privately practicing refractive surgeon will at some point in time be confronted with a LASIK chain or commercial clinic entering his market.
A RISING TIDE LIFTS ALL BOATS
Not everything about commercial clinics entering into a particular market is negative for the premium center. For premium clinics that do not advertise much—there are those that do, but certainly not to the same extent as commercial clinics—the addition of a nearby commercial clinic has the potential to spread the awareness of LASIK and refractive surgery to a wider audience than premium clinics can reach on their own. Raising awareness leads to more patients researching, and eventually investing in, refractive surgery.
When patients are ready to choose a refractive center, despite having possibly heard an advertisement for a commercial clinic, they many end up at a premium center. Part of the patient's research is most likely talking to other patients, and typically, the premium center generates business by word-of-mouth referrals. Potential patients also talk to general practitioners or optometrists about refractive surgery, and most times these specialists refer them to a premium clinic because of the service level associated with this type of practice. It goes without saying that the surgery and outcomes at premium refractive centers are excellent, otherwise the center would not be regarded as premium. Additionally—here the differences can really be telling—when surgical complications do occur, they are typically very well managed in a premium clinic.
However, the question remains: How do I distinguish myself from a commercial clinic? Attracting patients to visit your practice only goes so far if the patient feels he can get the same services down the street at a cheaper price. In this article, I describe several pearls for retaining your premium practice and differentiating it from the local commercial laser clinic.
DIFFERENTIATION
I do not think that bad-mouthing laser chains helps anyone. In the rare case that our patients inquire about a commercial laser center, it is better to prepare an honest answer than dismiss the topic. When confronted with a question (eg, "Can I have this done elsewhere for less?" or "Why does it cost more here?"), choose a diplomatic response. For example: "Well, that's a fair question and certainly I can provide you with some of the reasons to choose a premium center."
There are a number of variations on this theme, but many patients are satisfied with some or all of the following explanations.
Surgeon preoperative evaluation. First and foremost, reassure the patient that you will be personally reviewing his evaluation, as opposed to someone other than the surgeon at the commercial clinic. Typically, I tell patients the following: "I have first-hand knowledge from listening to you and performing your evaluation of exactly what you want from your surgery and have already looked at issues that may affect your surgery. In this way, I am better prepared for the surgery. In the other clinic, you are going to meet the surgeon only on the day of surgery."
Surgeon postoperative follow-up. In the same regard, I always tell the patient that I will be present at his follow-up visit, whether conducting the visit or being available for follow-up questions. My typical routine is to tell the patient, "Your aftercare will be under my direct supervision. In the other clinic, the surgeon is not going to see you afterward, as he is now doing surgery elsewhere."
Range of options available. Third, tell the patient that you perform all types of refractive surgery. Therefore, he can feel comfortable discussing other surgical options that may best suit his needs. I communicate the following: "At the commercial laser clinic, only laser is done. So it may happen that you have LASIK when a different refractive procedure may have suited you better."
Bait and switch. Do not forget to tell your patients about the strategy of bait and switch. I usually explain it as follows: "You may think that surgery costs less at the commercial chain, but it seldom does. Low prices are advertised to get you into the clinic; then, they try to get you to upgrade to a more expensive procedure." Most patients pay the same at cheap clinics as they do at premium centers; however, they only realize it afterward. I usually follow-up by saying, "At our center, what you see is what you get. There are no hidden charges or additional fees for aftercare or enhancement surgery." (Obviously this only applies to clinics where this is practiced.)
Word of mouth. Do not be afraid to ask the patient questions. "You landed here with me. Why is that?" You will find that it is almost always a word-of-mouth referral, especially if your center does not advertise. Why would I advertise on TV, the radio, and/or in print media if I were a commercial clinic? You need not say this out loud, but you are insinuating that clinics that advertise heavily are not generating enough word-of-mouth referrals.
VOCATION VERSUS PRODUCTION LINE
For most patients, the previously mentioned points are enough to convince them to choose the premium refractive center. On occasion, however, someone is not entirely satisfied. In these instances, stating the following helps: "It does not matter if the refractive surgery market collapses tomorrow; I will continue to practice refractive surgery irrespective of the economic climate. Business-led clinics will not stay around for the sake of charity. When refractive surgery is no longer profitable, they will shut their doors and find the next best and more profitable business. Here today, gone tomorrow. It has happened many times before, and it will happen many times again."
NONCOMPROMISING ETHICAL STANDARDS, COMMITMENT TO SERVICE
It is evident that building a strong word-of-mouth referral basis is important. However, referrals only happen if your clinic is set up as a premium center, meaning that (1) at every level of interaction with the patient (eg, first telephone call; first visit to the clinic; interaction with reception staff, nurses, ophthalmic assistants, technicians and optometrists), he is treated with respect and dignity; (2) patients are evaluated by or directly under the supervision of the surgeon; (3) surgery is carried out to the highest standards; and (4) results are analyzed and audited and any decrease in the quality of outcomes is detected early.
The biggest problem that patients have in regard to refractive surgery is their own fear. Hence, all that can be done must be done to address this issue. Reassure the patient that surgery is only an option if he is found to be a perfectly suitable candidate. The patient should never feel like he is on a conveyor belt that he cannot get off. Instead, make the patient feel like he is receiving individual, personalized information and care from the surgeon or ophthalmologist doing the work-up.
Give the patient a cooling down period to gather his thoughts; reflect on the evaluation; and make an informed, nonpressured decision. I have never studied this closely, but I believe that the average patient whom I reject for surgery provides as many referrals to the clinic as the patient who is delighted with his outcome. Patients need honesty; they are afraid that something may go wrong and need to be reassured that they are good candidates. Patients also need to be informed of the potential complications and risks. If they were one of the few unfortunate patients to encounter a complication, be sure they know ahead of time that you will provide every possible support and aftercare, including admittance to a hospital. (This is another distinguishing feature between the premium clinic and the chain because surgeons from a premium clinic have admitting privileges at the local hospital.)
MANAGING EXPECTATIONS
Continuously produce results that exceed expectations. When you see the patient before the surgery is scheduled, you can give him a realistic idea of what postop results will look like. We do a refraction and demonstrate a 0.75 D under- and over-correction to show the patient what the final result may look like. Inevitably, nearly all patients achieve a better result than what we demonstrated, setting the stage for the patient to be delighted with his result.
Laser chains make all sorts of unfounded claims, such as "Throw away your glasses." Making such claims or over-promising results to your patients only leads to potential disappointment. Someone who would otherwise have been happy with the result now finds himself unhappy because of unrealistic expectations. Under-promise and over-deliver is a mantra well worth practicing, although it does not work for the chain scenario.
On April 25, the US Food and Drug Administration's (FDA) Ophthalmic Devices Panel investigated post-LASIK quality-of-life issues. The hearing was a response to 140 letters of complaint, addressed to the FDA, about LASIK complications.1 Panel members concluded that the safety of the devices was not an issue—as some of LASIK's detractors would suggest—but that questionable clinical practices may be the true cause of many patients' dissatisfaction.2 (See Task Force Will Review Patient Satisfaction With LASIK, pg 53, for more information).
CONCLUSION
In summary, premium refractive clinics have patient satisfaction as their primary focus whereas chains have profits as their bottom line. The premium clinic does not try to lure patients with false claims or upgrade them to more expensive procedures. The premium clinic does not sell its technology—it goes without saying that the patient trusts the doctor to do what he thinks is best. In the setting of a premium refractive clinic, the patient is safe to believe that the doctor has the best technology in his hands; however, in the commercial model, the provider claims that its laser is best and encourages the patient to make use of its services or upgrade their procedure.
I am sure that there are many other differentiating factors between the premium refractive practice and the commercial LASIK chain, but the above-mentioned points are uppermost in my mind. These points are the most obvious to work on if you are faced with the task of trying to differentiate yourself from a commercial clinic down the road.
Arthur Cummings, FRCS(Ed), is the Medical Director of the Wellington Eye Clinic, Dublin, Ireland. Mr. Cummings may be reached at tel: +353 1 2930470; E-mail: abc@wellingtoneyeclinic.com.
